The Resolution of Hypertension after Adrenalectomy in Patient with Aldosterone - Producing Adenoma

A 52-year-old patient from Bangladesh, known for hypertension for the last year, was taking oral antihypertensives. Nonetheless, he still had uncontrolled blood pressure, and no associated symptoms. The patient was referred to Emergency with a presenting complaint of high blood pressure, and high aldosterone and low renin levels. Therefore, a subsequent work-up plan was recommended for him. As per the lab reports, the patient was found to be suffering from primary aldosteronism. This was concluded by looking at his lab values, which were seen to be as follows: Aldosterone: 320 ng/L, Renin: 2.55 ng/L, Potassium: 5.2 mmol/L. An MRI of the adrenal gland was ordered for this patient, both with and without contrast. The findings of the MRI were consistent with left adrenal adenoma. An approximately 14 x 10.4 x 10.8 mm, oblong-shaped focal lesion, along the maximum TS, AP, and CC dimensions was appreciated. This lesion was implicating the inferior portion of the left adrenal gland lateral limb, and exhibiting low to intermediate signal intensity on all provided sequences with signal dropout on out of the phase sequence. Moreover, minimal peripheral contrast enhancement was noted in the post-contrast administration images. This led to a prompt referral to the surgery department where the patient was evaluated and, within a week, operated on for the tumor successfully. This paper deals with the evaluation, diagnosis, and postoperative management of this patient who arrived at the hospital with no suspicion of the tumor that he had in his adrenal glands. Finally, it also summarizes the post-operative symptoms experienced by the patient and how they were managed on the spot to prevent any ensuing complications.